Pages

Monday, May 7, 2012

Customers at one of the Florida pain clinics run by Jeff and Chris George wait their turn in chairs on the sidewalk in surveillance footage shot by the Palm Beach Sheriff's Office.

By Thomas Francis Special to msnbc.com

The prescription painkiller business was booming in 2009, making millionaires of Chris and Jeff George, twin brothers who operated several pain clinics in South Florida. Unfortunately for them, their customers had a tendency to die, and not always in a subtle fashion.

In November of that year, three customers were on their way to a George brothers’ clinic when the driver tried to weave her Toyota Camry through the lowered arms of a train crossing. The car was struck by commuter train going 79 mph. The driver and a passenger were ejected from the vehicle and died at the scene. The third occupant died six months later.

An associate of the Georges who read about the accident in the paper called Chris George to break the news. “Did it say they were pain clinic people?” George asked.

It didn’t, but the Roxicodone scattered through the backseat of the crumpled car, and on both sides of the train tracks, made it obvious to investigators that this threesome from Tennessee didn’t come to Fort Lauderdale to get tans. (Roxicodone is a brand name for one of the prescription painkillers that contain oxycodone, the opioid that has a chemical structure like heroin, with roughly the same addictive qualities.)

Chris George worried that the accident would bring police scrutiny to the family’s pain clinics. To avoid situations like this, he and his workers coached their customers in keeping a low profile. “You’ve got to be an idiot to get hit by a train,” he complained.

What George didn’t know is that federal and local investigators had already targeted him and his brother – after oxycodone distributed at George clinics was found near the dead bodies of dozens who overdosed -- and were listening to that very phone call.

Chris George, left, and Jeff George, in police booking photos broadcast by a local TV station in Florida.

Chris and Jeff George, both of whom have pleaded guilty to some of the charges against them and reported to prison last month to begin serving long sentences, declined to comment for this series, citing concerns that their remarks would add to their legal difficulties. Federal agents and prosecutors also refused interview requests, due to related cases that remain open. The information in these articles was gleaned from court records, interviews with associates of the Georges and informants, many of whom spoke on condition of anonymity.

Fueling an oxy epidemic South Florida -- and the Georges, in particular -- were the vanguard of what the Centers for Disease Control and Prevention calls an “epidemic” of oxycodone addiction and death -- one that had attacked America more suddenly than any drug has before.

In 2008, prescription painkiller overdoses killed 14,800 Americans. In 2009, when the George clinics were at their peak, opioid abuse propelled a ghastly rise in the number of drug-related deaths nationwide. That year, 37,485 Americans died from narcotics overdoses -- a figure that for the first time surpassed the number of deaths from car accidents.

“The toll our nation’s prescription drug abuse epidemic has taken in communities nationwide is devastating, and Florida is ground zero,” said Obama drug czar Gil Kerlikowske, speaking at a press conference last year.

In 2009, Florida was one of 15 states that lacked a prescription drug tracking system, which enabled buyers to fill overlapping prescriptions without being flagged as drug abusers. That made the state susceptible to abuse on a grand scale.

The Georges were not rags-to-riches drug dealers. They were born to a wealthy home builder named John George and grew up in Wellington, an ultra-affluent community known for its polo grounds and celebrity residents, including Bruce Springsteen.

South Florida was one of the first regions to be struck by the bursting of the housing bubble. By 2006, when the George family’s Majestic Homes was the featured builder on an episode of “Extreme Makeover: Home Edition,” the business was already in a tailspin. John George said that buyers were breaking their contracts because the homes were depreciating so rapidly, causing construction delays. Other buyers then complained, he said, earning Majestic an “F” from the Better Business Bureau.

To cut costs, George closed the Majestic Homes office on Florida’s west coast run by Chris George, who moved back east across Alligator Alley to his native Palm Beach County. When he arrived, he soon learned that his brother, Jeff, had found an enterprise more lucrative than home building.

Jeff George, who has the broad shoulders and bull neck of an avid weightlifter, was selling steroids online. A physician wrote prescriptions to the buyers without having conducted a physical examination, according to a criminal indictment. That made the practice illegal.

While moving through this black market, Jeff George made the acquaintance of a physician named William Overstreet. Versed in the nuances of Florida’s health care regulations, Overstreet suggested to George that the real money was in oxycodone, court records indicate.

Overstreet was an authority on this subject. Based on his generosity dispensing pain pills, local cops nicknamed him the “Candy Man,” according to the criminal indictment of the Georges.

With Overstreet’s coaching, Jeff George opened South Florida Pain Center in early 2008 in a small shopping plaza north of Fort Lauderdale. Brother Chris soon joined the business, according to court records.

Recruiting physicians on Craigslist To find physicians, the Georges posted Craigslist ads that promised generous pay. Job interviews were straightforward: the Georges wanted to know whether the physician was licensed by the state and registered with the DEA to prescribe controlled substances. Most important, according to the indictment, that physician had to be willing to prescribe with a heavy hand – including a drug “cocktail” of oxycodone and the anti-anxiety drug Xanax. Users often take oxy and Xanax simultaneously – a combination that killed actor Heath Ledger in 2008.

The doctors who collaborated with the Georges had financial incentives to risk their licenses.

Dr. Patrick Graham, for instance, maintained a successful plastic surgery practice in Boca Raton for decades, until he discovered that an office manager had been embezzling the clinic’s profits, according to friends who wrote letters to the court on his behalf. By the time he found out, it was too late to save the practice. Without enough savings to retire comfortably, and too proud to ask his professionally accomplished siblings for help, the 64-year-old Graham began working at a George clinic in July 2009.

He had misgivings. In one recorded call detailed in court records, Graham was asked by Chris George to turn over some of the oxycodone he had ordered, presumably so that George could sell it to street dealers. Said Graham: “I think the idea is that I’ll do this one time, but I don’t like playing around with this stuff. This is just not something that you (do) in a medical setting.” (Graham, who was sentenced to four years in prison for his role in the Georges’ operation, declined to comment for this article.)

Skeptical physicians were assured that pain clinic practice had been vetted by attorneys and was entirely legal. Each clinic was structured to insulate the workers from prosecution and to maximize the flow of painkillers, according to the indictment.

The Georges’ pain clinic customers were directed first to a mobile MRI unit, parked behind a West Palm Beach strip club. Since every individual’s spinal column has differences in alignment, the scans were used to support diagnoses that “irregularities” were causing the patient’s pain, a claim too subjective to dispute, according to the indictment.

Patients were required to submit urine samples to demonstrate that they weren’t abusers. But the George clinics looked the other way when patients swapped clean urine, a practice that was so common that the clinic toilets would often become clogged after patients tried to flush condoms and containers they’d smuggled into the restroom, according to the indictment. Even when the urinalysis showed the presence of narcotics, lab technicians (many of whom were friends of the Georges) waved the patients through, directing them to other clinics run by the Georges for a physician’s exam, it said.

Although “exam” may not be the best word. It was more like a physician’s glance. Undercover investigators said pain clinic doctors devoted an average of three minutes to each patient, ignoring the results of the MRIs, failing to inquire about the patient’s medical history and neglecting to ask the questions necessary to make an objective diagnosis, according to testimony by agents in DEA hearings.

To save physicians’ hands from cramping, they were given stamps with which to “sign” prescriptions.

Said Michael Aruta, one of the fastest-moving physicians: “These hillbillies don’t give a s--- about their health.” Powerful painkillers, he added, are “all they’re here for,” the indictment said. (Aruta, who was sentenced to six years in prison, declined to comment for this article.)

Having received their scripts, customers were guided to pharmacies controlled by the George family. Chris George’s wife, Dianna, volunteered to help dispense the drugs. Given the dangers of mixing a deadly dose of medication, pharmacists are trained to take specific safety measures. Dianna’s previous job was dancing at a strip club.

Efficiency becomes a problem The efficiency of the George clinics soon became a problem. Shortly after the South Florida Pain Center opened in 2008, the brothers outgrew it. Jeff George opened East Coast Pain in West Palm Beach and Hallandale Pain in the South Broward County city of Hallandale Beach. In summer 2008 Chris George opened a clinic he called American Pain in Boca Raton. But the voracious appetites of his pill mill customers made it necessary to find an even bigger location, which is what led him in 2009 to launch the new American Pain in a 20,000 square-foot building in Lake Worth, near a mostly immigrant neighborhood. Immigrants don’t call cops, George said during a recorded phone call.

American Pain was the biggest single clinic in the country, a Super-Walmart of addiction. Investigators say that the five most generous script-writing doctors saw 500 patients per day and, at up to $100 per patient, earned nearly $2 million in a year’s time.

Said Dr. Graham during a recorded conversation with Chris George: “You make a lot more money doing this than doing plastic surgery.” Indeed, George was heard bragging that physicians who worked for him made an average of $35,000 per week.

The parking lot and surrounding streets were lined with cars bearing plates from Kentucky and Tennessee, hotbeds for painkiller abuse. To make it less conspicuous, the clinic instructed patients to park in lots several blocks away, where they’d be picked up by a shuttle van and delivered to the clinic’s front door.

To keep the painkillers coming by the truckload, the Georges also needed to deceive the pharmaceutical suppliers. Investigators recorded a conversation where George told an employee, “Remember, we’re lying about how many (clinic customers) are out of state. If you give them our real dispensing log it’s going to show that everybody’s from out of state.”

For drug dealers in states like Kentucky or Tennessee, the 1,000-mile trek to South Florida paid for itself, and it became common for them to fill a van with people willing to pose as patients with chronic pain. On average, clinic patrons (or their sponsors) paid about $5 per 30-mg dose of oxycodone, which they could sell in Appalachia for $30. Just one of the George brothers pharmacies could dole out over 10,000 doses of 30-mg oxy in a single day.

In addition to the millions of oxy doses the clinics administered over the counter, thousands more were diverted by George employees to street traffickers, who paid cash, according to investigators’ filings.

The grip of oxy addiction guaranteed a loyal customer base. The more patients the clinics served, the more customers lusted for another fix. According to a DEA agent’s testimony in an administrative hearing, it was common to see 30 patrons in a queue before American Pain opened at 7 a.m., many of them itching compulsively, dressed in ragged clothing and chain-smoking cigarettes. The most woebegone addicts had track marks on their arms and appeared to be under the influence of drugs, the agent said.

Security workers cruised the clinic grounds in golf carts, steering customers to the clinic door and punishing those inclined to loiter. At Jeff George’s clinics, a friend, Derik Nolan, became an enforcer, delivering beatings to patrons who did anything that could attract police, such as snorting the drugs outside the clinics or handing them to a dealer. Proud of his role, Nolan was heard on the wire boasting, “I’m like the f----ing underboss here. I’m the one who knows all (Jeff’s) dirty little secrets and the f----ing one that gets called when s--- needs to get done.”

Nolan who pleaded guilty to his role in managing the pill mills and was sentenced in December to 14 years in prison, referred questions to his attorney, who declined to comment.

As patients jumped ahead of others in line, fights broke out. It was also common for patients to have drug-induced overdoses and seizures. On the day after the train killed the group from Tennessee, another clinic customer was found dead on the side of a South Florida highway.

John George, father of the two brothers, says that the clinics were operating within the law and that any illegal activity that occurred there was the fault of rogue physicians. He did not have a role in the clinics and was not charged with any wrongdoing in connection with the case.

Burning dollar bills in barrels The deluge of cash became a problem. Employees could be heard on the wiretaps complaining about cash drawers being stuffed to the top. It wasn’t worth keeping dollar bills, so those were separated and then burned by the barrel. Bigger bills were stuffed into garbage bags, then hauled to a bank. Chris George’s wife, Dianna, accepted the chore of making these rather suspicious deposits, although not without grousing that she’d become her husband’s “money mule.”

Other cash-filled bags went to the home of the Georges’ mother, Denice Haggerty, who stacked it in safes in her attic. At one point, says a friend of the Georges, there were 14 safes in the attic, each containing $1 million. Haggerty, who divorced John George in 1988, pleaded guilty to conspiracy to commit wire fraud and was sentenced to 30 months in prison.

The cash piled up despite the brothers’ free-spending ways. Jeff George bought a monster truck, multiple Lamborghinis and a Mercedes Saks 5th Avenue Edition. There were only five of those cars made, and George liked his so much that when he totaled it, he bought himself another, according to a friend.

Jeff George assembled a small navy, including a 36-foot racing vessel, a 39-foot sports boat and two yachts, 38 and 55 feet in length. He also bought the shopping plaza housing his favorite strip club. The purchases were a convenient way to launder money, according to the indictment.

As the Georges’ painkiller empire grew, it attracted enemies, both from within and without. The indictment cites recorded phone calls in which Chris George and Derik Nolan threatened violence against other pain clinic operators they perceived to be encroaching on the Georges’ turf.

The Georges learned to suspect treachery even from their friends. A roommate of Jeff George named Robert Eddy was thought to have stolen some $500,000 in clinic funds. According to federal filings and testimony in pre-trial hearings, the brothers had Eddy handcuffed then brought to a vacant home owned by Jeff George. To intimidate Eddy, Jeff George allegedly fired a gun just inches from Eddy’s head, according to the indictment. Eventually, he was released unharmed. Chris George allegedly gave Eddy $10,000 to keep quiet about the incident, although court filings indicate the brothers remained dubious about Eddy’s loyalty.

The incident may have made Jeff George paranoid about his other friends and clinic associates. According to the indictment, he put employees through lie detector tests. Chris George had his clinic regularly swept for listening devices.

They even had doubts about whether they could trust the man who introduced them to the painkiller business, Dr. William Overstreet. Multiple sources with knowledge of the investigation say that the Georges had a dispute with the so-called “Candy Man” over money.

Overstreet left the pain clinic business around 2009, moving to Panama. Shortly thereafter, Overstreet’s car reportedly flew off a cliff, killing him. The U.S. Consulate confirmed the death of an American by that name, though it refused to give a date or the manner of death, citing privacy rules.

Jeff George made multiple trips to Panama and Costa Rica while the pain clinics were in business, but there’s no evidence he was there at the time of Overstreet’s death, and there are no filings in the drug trafficking case to suggest that he had any role in it.

Despite the internal conflicts, the brothers’ clinics were thriving like never before in early 2010, having made nearly $1 million in a single week in late February. But on the morning of March 3, they were awakened by urgent phone calls: The clinics were being raided by a DEA task force.

Even as masked agents emptied file cabinets and hauled off boxes of pills, clinic customers walked past them to the front desk, demanding new prescriptions. At the same time, agents were swarming through the George brothers’ homes and counting the millions of dollars squirreled away in their mother’s attic.

'I'll take the fall' Jeff George managed to keep a stiff upper lip. When a reporter for the Palm Beach Post called, he said, “It’s unfortunate for the patients that they have nowhere to go now. They are the ones that are really going to be affected the hardest by this.”

Meanwhile, Chris George, who spent the morning driving in his SUV between clinics, was panicking. The feds were listening on the wire when he told his wife, Dianna, “I’m f----ed.” He added, “Babe, I don’t know. Maybe I should just kill myself.”

Said Dianna George, “I’ll take the fall for everything, OK?”

But perhaps there was another way out. With investigators needing months to sift through the medical records they collected at the George clinics, it would take time before the Georges were formally charged with crimes.

In pretrial hearings, prosecutors alleged that Chris George discussed with an informant named Zack the murder of Robert Eddy, the former friend who had been handcuffed and threatened after it was believed he stole $500,000. Nothing came of the alleged plot, and Chris George was not charged with attempted murder.

But he may have deployed another strategy for deterring witnesses. In October 2010, Chris George got a tattoo on his lower leg: a rat, its lifeless body hanging from a noose. A friend took a picture of the tattoo, then texted it to a witness in the case.

Prosecutors moved swiftly, hauling George into court and citing the rat tattoo as evidence that the clinic kingpin was a threat to government witnesses and should be jailed without bond. A federal judge agreed.

Having apparently exhausted all other ideas, in 2011 the George brothers finally agreed to testify against the doctors they hired at the clinics. That, as well as guilty pleas to racketeering charges, would spare them from going to trial and risking a sentence that would put them in prison for the rest of their lives.

Jeff George came to his January sentencing hearing dressed in a double-breasted suit, hands clasped contritely in front of him. His hair, frosted at the tips when he began the clinic business, was now streaked with gray. “I realize what I did was 100 percent wrong,” he told the judge. “I take 100 percent responsibility.”

The judge sentenced him to 15 1/2 years. George has also pleaded guilty to a state case of murder in the case of a patient named Joey Bartolucci, who died by overdosing on oxycodone he received at East Coast Pain clinic. The sentence in that case may bring George’s total prison stay to 20 years.

Chris George, who also pleaded guilty to racketeering, was sentenced to 17 1/2 years. In all, 26 of the brothers’ associates will serve time, including Chris George’s wife Dianna and the Georges’ mother, Denice Haggerty, both for over more than a year. Of the nine doctors indicted in the federal case, seven have entered guilty pleas -- the first time that doctors have been convicted in a “pill mill” racketeering case. The remaining two appear likely to go to trial, currently set for August.

20 million pills in three years During the nearly three years that Georges’ four primary clinics operated, investigators estimated that they churned out roughly 20 million doses of oxycodone.

Based on what they learned from listening to wiretaps, federal prosecutors believe that the Georges made at least $40 million through the pain clinic and other fraudulent enterprises. In the raid, the government seized about $5 million in cash and property worth $9 million. The rest of the money is still unaccounted for.

It’s much harder for the government to calculate the human casualties of the George clinics. By cross-referencing files from the Florida Medical Examiners Commission, investigators found that the George’s drugs had a role in 53 overdose deaths in Florida alone. Considering that 80 percent to 90 percent of the patients came from out of state, the number of deaths that occurred outside of Florida must be far greater. As a federal prosecutor noted at one hearing, “We don’t know how many kids died behind barns in Tennessee, Ohio, Kentucky and West Virginia” -- the Appalachian states home to the Georges’ most loyal customers.

The brothers may have known that their drug-dealing in Florida wasn’t going to last. Thanks to new state laws regulating the amount of oxycodone a single doctor can purchase, sales of the drug declined 97 percent from 2010 to 2011, according to figures cited by Obama drug czar Kerlikowske at a congressional hearing on March 1.

In the Georges’ former base of Palm Beach County, the number of pain clinics likewise plummeted by 65 percent in the past year, according to Sheriff Ric Bradshaw, who said that the remaining clinics are either under investigation or are legitimate practices.

These developments may have played a role in the Georges’ interest in taking their enterprise national. At the time they were raided, the brothers had recently launched a clinic in Kennesaw, Ga. and were scouting locations in Texas and St. Louis.

Considering that the Georges’ physicians ranked among the nation’s biggest oxycodone purchasers, the bust of their South Florida clinics played a major role in reversing both local and national trends of rapidly increasing painkiller abuse.

Despite the hard fall taken by his sons, who began serving their prison sentences on April 27, real estate developer John George still maintains that they were victims of physicians who broke the law. “We had every indication that what (the clinics) were doing was perfectly legal,” he said. “My sons aren’t doctors. They counted on the doctors and their staff to do their work correctly, but they didn’t.”